COVID-19: Are men at greater risk?

Despite a similar prevalence of COVID-19 between sexes, men may have a greater risk of severe outcomes and mortality, according to a study from China.

“Early in January we noticed that the number of men dying from COVID-19 appeared to be higher than the number of women,” said study author Dr Jin-Kui Yang from the Beijing Tongren Hospital in Beijing, China. “This raised a question: Are men more susceptible to getting or dying from COVID-19? We found that no one had measured gender differences in COVID-19 patients, and so [we] began investigating.”

To assess the effect of sex on COVID-19 morbidity and mortality outcomes, Yang and his colleagues examined a case series of 43 of their patients hospitalized and treated for COVID-19 at Wuhan Union Hospital, Wuhan, China, between 29 January and February 15, 2020, and a public data set of 1,056 patients with COVID-19 from China (comprising the first 37 deaths and 1,019 survivors).

Greater illness severity and mortality in men

In the case series, the median age of the patients was 62 years and did not significantly differ between sexes. About one-third of the patients (37.2 percent) had an underlying comorbidity. Thirteen patients (30.2 percent) had mild or moderate pneumonia, 14 (32.6 percent) had severe pneumonia, and 16 (37.2 percent) had critical pneumonia. A higher level of COVID-19 disease severity was demonstrated in men compared with women (p=0.035). [Front Public Health 2020;8:152]

The findings from the case series were echoed in the public data set which showed a more than twofold risk of death from COVID-19 in men vs women (70.3 percent vs 29.7 percent; p=0.016).

“While men and women had the same susceptibility, men were more prone to dying,” noted the researchers.

“[The results of the study suggested that] gender is a risk factor for higher severity and mortality in patients with COVID-19, independent of age and susceptibility,” they said.

The patients who died were significantly older than those who survived (median age 70 vs 47 years; p<0.01), with a greater proportion of patients aged ≥65 years in the deceased group (83.8 percent vs 13.2 percent). There were no deaths among patients with COVID-19 aged <14 years (n=30). Ages were comparable between men and women regardless of whether they died or survived.

The median period between symptom onset and death was 13 days. Almost 65 percent of patients who died had ≥1 underlying comorbidity.

Similar outcomes in SARS?

Due to similarity between the virus causing COVID-19 and that of the SARS-CoV infection in 2003, the researchers also examined the influence of sex in a cohort of 524 patients diagnosed with SARS (including 139 deaths) in Beijing between 25 March and 22 May, 2003. Fifty-seven percent had ≥1 comorbidity and the mean period between symptom onset and death was 15 days.

Patients who died were older than those who survived (median 57 vs 32 years; p<0.001) and were more likely to have comorbidities (57.0 percent vs 17.9 percent; p<0.001). A greater proportion of men died than survived the disease. There was little difference in age between men and women with SARS who died and survived, though mortality rate was higher in men than women (31.2 percent vs 22.6 percent; hazard ratio, 1.47; p=0.026).

Are men at greater risk?

The researchers acknowledged that the small sample size of the case series and deaths in the public data cohort to assess COVID-19 severity and mortality, respectively, may have affected the findings. They called for more research into assessing the role of sex and other prognostic factors in COVID-19. Nonetheless, the results point to a higher risk of negative outcomes in male patients, they said.

“We recommend that additional supportive care and prompt access to the intensive care unit may be necessary for older male patients,” said Yang.